EmblemHealth Provider Information

About Emblem Insurance

EmblemHealth has provided health coverage since the 1930s, offering various health plans, like Medicaid and Medicare and private plans, to businesses, families, individuals, retirees, and government workers for addiction treatment and mental health services. EmblemHealth centers on practicing a whole-person method of health care insurance to help members stay healthy for the long term by ensuring mental health services and addiction treatment services are accessible through insurance coverage.

Mental health and substance abuse coverage levels will vary for each member based on their state of residence and insurance plan. However, most EmblemHealth plans cover at least a portion of substance abuse treatment, including partial hospitalization programs, intensive outpatient programs, and inpatient and residential programs for alcohol rehab, addiction rehab, and co-occurring disorder treatment.

In most cases, a treatment program will need to be pre-authorized regardless if it is an inpatient treatment program, an intensive outpatient program, or another type of substance use disorder treatment. Also referred to as prior authorization, the health insurance company will decide if a healthcare service or treatment is medically necessary. Outpatient treatment and emergency visits usually will not require reauthorization, but inpatient rehab programs or a partial hospitalization program may require prior approval to ensure your insurance benefits cover treatment.

EmblemHealth will normally require members to meet deductibles, co-payments, or coinsurance for mental health treatment services and addiction treatment services for co-occurring disorders, substance addictions, or mental health, especially if in a higher intensity treatment setting like the inpatient programs offered at Behavioral Health Centers.

If you or someone you love is looking for a rehab for mental health treatment or substance abuse services that takes EmblemHealth insurance, contact us today at 772-774-3872 to have our team run a confidential, no-cost verification of your benefits, or click here to complete our insurance form so you can get help today.

Does EmblemHealth Cover Substance Abuse Treatment?

When inquiring into substance abuse treatment, it is always important to verify your insurance provider’s approval and confirm what’s covered on your plan. EmblemHealth covers at least part of any routine outpatient treatment program costs at any of their network facilities without requiring prior approval with most plans.

 

Types of Substance Addictions EmblemHealth Typically Covers

EmblemHealth usually covers substance addiction treatment and co-occurring disorders, also referred to as dual diagnosis. A co-occurring disorder is when somebody is suffering from mental health and substance abuse disorder simultaneously.

Substance abuse disorders that are usually covered by EmblemHealth include:

Most substance abuse treatment centers can treat these listed substance use disorders. The rehab center’s admission counselors will assess the suitable level and care type needed for the subject.

Most patients will start with a higher-intensity treatment setting, like residential treatment, before transitioning to a more moderate level of care, like outpatient treatment. A medical detox treatment will be needed before treatment gets started to flush the body of drugs and alcohol.

Medical Detox Treatment

Medical detox treatment helps patients flush the drugs and alcohol from their bodies until they no longer feel the withdrawal effects. The time and length it takes to detox from drugs and alcohol are based on the substance used and addiction severity.

The withdrawal timeline from specific substances are:

  1. Alcohol can last between 2 and 10 days
  2. Benzodiazepines can last 2 to 8 weeks and sometimes longer
  3. Stimulants like amphetamines and cocaine normally last between 3 and 5 days
  4. Short-acting opioids, like heroin, can last between 4 and 10 days, while long-acting opioids, like methadone, can last between 10 and 20 days

A detox could require withdrawal management, which entails round-the-clock supervision by a specialist who can administer medications. Withdrawal from benzodiazepines and alcohol can cause severe reactions like hallucinations, seizures, and extreme agitation.

Residential Treatment

Residential treatment programs offer patients a safe, substance-free, controlled environment to help them recover.

These living facilities offer 24-hour support of medical supervision and access to medications when needed. Some residential treatment programs are equipped to treat patients with more severe medical conditions like experiencing psychiatric trauma. These live-in programs are usually found in hospitals or medical centers. Residential treatment also provides round-the-clock support, but these rehab programs are usually housed in freestanding buildings rather than hospitals.

Residential treatment programs are best for those who don’t have a supportive or sober living environment at home. Residential treatment programs provide patients with individual and group therapy, with patients usually staying between 30 and 90 days.

Partial Hospitalization Program

Partial hospitalization programs will meet during the day, several days a week, for roughly 4 to 6 hours each day. Patients enrolled in a partial hospitalization program will receive many of the same treatments and therapies as those in residential programs without round-the-clock monitoring. The patient returns home each night and visits the treatment center periodically to receive substance addiction treatment.

Intensive Outpatient Program

Patients in an intensive outpatient program will meet for therapy several days a week for 3 to 5 hours per day. Intensive outpatient programs will offer the same therapies as partial hospitalization programs and residential treatment programs but meet less often. Like partial hospitalization programs, patients can return home at night.

Outpatient Treatment

Outpatient rehab programs will normally meet 1 to 2 days a week and offer more flexibility for work, school, and family obligations.

Treatment Services Covered

EmblemHealth usually covers addiction treatment services that include:

  • Assessments
  • Exams
  • Lab work
  • Medications
  • Therapy

EmblemHealth Mental Health Coverage

A good health insurance package can make receiving quality mental health services more affordable. EmblemHealth provides health insurance to millions of people all over the East Coast. If you have EmblemHealth coverage, you can benefit from the mental health treatment services offered by experts at Behavioral Health Centers.

EmblemHealth divides its health insurance plans into three categories: Individual & Family, Employer and State-Sponsored. All plans with the provider cover mental health services per the Affordable Care Act. However, your plan may require paying some out-of-pocket costs for the deductible, co-pay or coinsurance.

Individual & Family plans include:

  • Essential: Tier 1 has a $15 co-payment for outpatient mental health services and a $150 co-payment for inpatient treatment. Tiers 2 and 3 don’t have deductibles or co-payments for mental health treatment.
  • Basic: Individual has a $9,100 deductible, while Family has an $18,200 deductible. Both tiers have 0% coinsurance for mental health treatment after the deductible.
  • Silver: Individual has a $1,750 deductible, while Family has a $3,500 deductible. Outpatient mental health services require a $30 co-pay, while inpatient services have a $1,500 co-payment.
  • Gold: This plan has a deductible of $600 for Individual and $1,200 for Family. A $25 co-payment for outpatient mental health and a $1,000 co-payment for inpatient services are required.
  • Platinum: This plan has a $0 deductible but requires a $15 co-payment for outpatient mental health services and a $500 co-payment for inpatient services.

EmblemHealth Mental Health Insurance Coverage through EAP

Employers can also provide individuals and families with EmblemHealth insurance coverage. You may be enrolled in a plan requiring high deductibles and coinsurances or a plan with no deductible, co-pay or coinsurance for mental health treatment. The provider analyzes the size of each company to customize mental health benefits for each plan in this category.

EmblemHealth’s state-sponsored plans include the following:

  • Medicaid Managed Care: This offers comprehensive outpatient and inpatient behavioral and mental health care with no co-pays or coinsurance
  • Enhanced Care Plus (HARP): It covers  behavioral health with no monthly premiums

Length of Addiction Treatment EmblemHealth Covers

Receiving confidential and discreet substance addiction treatment is important, but there is no typical rehab duration that your insurance plan will cover. EmblemHealth does limit the length of outpatient treatment to 60 appointments per patient per calendar year. Staying within that limit will typically have 100% of the costs covered for any network rehab center. For the patients that require private treatment, payment for additional sessions will be completely on them.

Explanations of a deductible, co-payment, and coinsurance include:

  1. A deductible is the responsibility of the member to pay upfront for covered services prior to the health insurer covering costs. For example, members with a $500 deductible plan must pay upfront the first $500 of coverage costs.
  2. A co-payment is a set fee that members finance for treatment. It is usually required before, but sometimes after a member has paid their deductible.
  3. Coinsurance is a percentage of the entire cost for a covered treatment a member is liable for after their deductible has already been satisfied. Health plans with more expensive monthly premiums will usually have lower co-payments and coinsurance rates than those with lower monthly premiums.
Patient receiving mental health care using insurance coverage from EmblemHealth
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Suppose you or a loved one is covered under EmblemHealth insurance and requires a medical facility to assist with detox before seeking rehab. In that case, these treatments are normally covered under the plan. EmblemHealth is a non-profit health insurance company that covers more than 3 million residents of Connecticut, New Jersey, New York State, and the tri-state New York City area. EmblemHealth will usually cover substance abuse treatment and mental health disorders, depending on the specific plan. Even if the plan provides coverage, members could still be responsible for deductible costs, copayments, and coinsurance to cover addiction treatment.

Mental Health Treatment Offerings at Behavioral Health Centers

Behavioral Health Centers has had a long relationship with EmblemHealth. Your insurance plan can cover inpatient treatment at our facility or allow you to receive services through our partial hospitalization program (PHP). Both inpatient and PHP treatment give you access to various intensive therapies, including cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT).

We Accept Most Insurance

Behavioral Health Centers does not accept Medicare or Medicaid.

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How to Cover What EmblemHealth Insurance Won’t

For those with an EmblemHealth plan who don’t have upfront money for addiction treatment that your plan doesn’t cover, you may want to check with providers that can offer payment plans. Overall, patients usually have several different choices to cover substance addiction treatment, which include:

  • Borrowing from friends or family
  • Payment plans
  • Personal loans
Insurance coverage and health insurance plans from Emblem health reduced out of pocket costs for mental health services and addiction treatment
mental health services and addiction treatment covered by EmblemHealth health insurance plans

Verifying Coverage and Finding the Best Treatment

In regards to verifying coverage plans, EmblemHealth makes the process quite simple. Members can seek treatment at an approved outpatient treatment facility within its network. This means members can show up at any network provider and receive substance addiction treatment that is needed almost immediately. While some members might be skeptical in choosing outpatient treatment, according to statistics on substance addiction rehabs, residential and outpatient treatment centers’ success rates are almost the same.

It would be best to locate the appropriate treatment center and rehab facility to tailor an addiction treatment program to fit your specific addiction treatment needs. For those who need help finding a rehab center, it is advised to call EmblemHealth to learn more about your plan.

The best way to verify your EmblemHealth insurance benefits for drug and alcohol rehab is by reaching out to our admissions specialists to discuss your addiction treatment options. Everything is confidential to speak freely about your mental health or substance abuse disorder, so call us today at 772-774-3872 to learn more about what mental health treatment and substance abuse treatment is covered by EmblemHealth insurance.